Toxic risks and nutritional benefits of traditional diet on near visual contrast sensitivity and color vision in the Brazilian Amazon.

BACKGROUND: Visual functions are known to be sensitive to toxins such as mercury (Hg) and lead (Pb), while omega-3 fatty acids (FA) and selenium (Se) may be protective. In the Tapajós region of the Brazilian Amazon, all of these elements are present in the local diet. OBJECTIVE: Examine how near visual contrast sensitivity and acquired color vision loss vary with biomarkers of toxic exposures (Hg and Pb) and the nutrients Se and omega-3 FA in riverside communities of the Tapajós. METHODS: Complete visuo-ocular examinations were performed. Near visual contrast sensitivity and color vision were assessed in 228 participants (≥15 years) without diagnosed age-related cataracts or ocular pathologies and with near visual acuity refracted to at least 20/40. Biomarkers of Hg (hair), Pb (blood), Se (plasma), and the omega-3 FAs eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in plasma phospholipids were measured. Multiple linear regressions were used to examine the relations between visual outcomes and biomarkers, taking into account age, sex, drinking and smoking. RESULTS: Reduced contrast sensitivity at all spatial frequencies was associated with hair Hg, while %EPA, and to a lesser extent %EPA+DHA, were associated with better visual function. The intermediate spatial frequency of contrast sensitivity (12 cycles/degree) was negatively related to blood Pb and positively associated with plasma Se. Acquired color vision loss increased with hair Hg and decreased with plasma Se and %EPA. CONCLUSIONS: These findings suggest that the local diet of riverside communities of the Amazon contain toxic substances that can have deleterious effects on vision as well as nutrients that are beneficial for visual function. Since remediation at the source is a long process, a better knowledge of the nutrient content and health effects of traditional foods would be useful to minimize harmful effects of Hg and Pb exposure.

Evaluation of Sodium Hyaluronate Lubricating Drops Used before Insertion of Contact Lenses on Symptomatology, Severity, and Intensity of Ocular Dryness.

Purpose. This study aimed to evaluate outcomes from the use of a sodium hyaluronate (SH)-based comfort drop, instilled before the insertion of contact lenses, in a population of symptomatic contact lens wearers. Methods. This was a cross-over, open-label, multi-sites study. Subjects were fitted with silicone hydrogel lenses and followed for two months. Before insertion of the lenses, SH drops was instilled in the lens for half of the group. The other half did the same on the second month. Objectives and subjective outcomes were measured and compared before from baseline with the ones collected after usage of SH drops.

Neurotoxic sequelae of mercury exposure: an intervention and follow-up study in the Brazilian Amazon.

Since 1995, the Caruso Project used an Ecosystem Approach to Human Health to examine mercury (Hg) exposure in fish-eating communities in the Brazilian Amazon and develop interventions to maximise nutrition from traditional diet and minimise toxic risk. In 1995, 2000 and 2006, this study followed fish consumption, Hg levels, and visual and motor functions in 31 villagers. Questionnaires gathered information on socio-demographics and diet. Hair Hg (H-Hg) levels were measured. Visual acuity, colour vision, manual dexterity and grip strength were assessed. Data was analysed using general linear models of repeated measures. Total fish consumption, similar in 1995 and 2000, decreased in 2006. Carnivorous fish consumption initially decreased and then remained stable, whereas non-carnivorous fish consumption first increased and then decreased. H-Hg declined from 17.6 to 7.8 µg/g. Visual functions showed a significant decrease over time, with those with H-Hg ≥ 20 µg/g in 1995 showing greater loss. Motor functions showed initial improvement and then returned to the 1995 performance level. Decrease in Hg exposure is attributed to the intervention and socio-economic changes in the village. While there may be a certain reversibility of motor deficits, visual capacities may decrease progressively with respect to exposure prior to the intervention.

Visual acuity in fish consumers of the Brazilian Amazon: risks and benefits from local diet.

OBJECTIVE: To examine the associations between near and distant visual acuity and biomarkers of Hg, Pb, n-3 fatty acids and Se from the local diet of fish-eating communities of the Tapajós River in the Brazilian Amazon. DESIGN: Visuo-ocular health and biomarkers of Hg (hair, whole blood, plasma), Pb (whole blood), Se (whole blood and plasma) and n-3 fatty acids (plasma total phospholipids) were assessed in a cross-sectional study. SETTING: Lower Tapajós River Basin (State of Pará, Brazil), May to July 2006. SUBJECTS: Two hundred and forty-three adults (≥15 years) without diagnosed age-related cataracts or ocular pathologies. RESULTS: Near visual acuity was negatively associated with hair Hg and positively associated with %DHA, with a highly significant Log Hg × age interaction term. Stratifying for age showed that while young people presented good acuity, for those aged ≥40 years, clinical presbyopia was associated with hair Hg ≥ 15 µg/g (OR = 3·93, 95% CI 1·25, 14·18) and %DHA (OR = 0·37, 95% CI 0·11, 1·11). A similar age-related pattern was observed for distant visual acuity in relation to blood Pb, but the evidence was weaker. CONCLUSIONS: These findings suggest that Hg and Pb may affect visual acuity in older persons, while DHA appears to be protective for near visual acuity loss. In this population, with little access to eye care, diet may have an important influence on visuo-ocular ageing.

Selenium from dietary sources and motor functions in the Brazilian Amazon.

Selenium (Se) is a well-known anti-oxidant with a critical role in the proper functioning of nervous and muscle functions. Se deficiency has been associated with both cognitive and neuromotor impairment, while sensory and motor deficits have been attributed to excess Se. In the Lower Tapajós Region of the Brazilian Amazon, riverside populations present a wide range of Se levels. These fish-eating communities have among the highest mercury (Hg) exposures reported in the world today, and recently, lead (Pb) exposure has been identified. Some studies suggest that Se intake can be protective for Hg and/or Pb toxicity, however, data from animal and human studies are inconsistent. The objective of the present study was to examine the relations between biomarkers of Se and motor functions, taking into account co-variables and biomarkers of exposure to Hg and Pb. Participants (n=448), aged 15-87 y, were recruited from 12 communities along the Tapajós River. Se concentrations were measured in whole blood (B-Se), plasma (P-Se), hair (H-Se) and urine (U-Se) by ICP-MS. Whole blood Hg (B-Hg) and Pb (B-Pb) were also measured by ICP-MS. Interview-administered questionnaires served to collect information on socio-demographics and medical history. All participants underwent a complete visual examination and performed tests of motor functions (Branches Alternate Movement Task, Santa Ana Test, Dynamometer and Grooved Pegboard Test). B-Se varied from 103 to 1500 µg/L (median 228 µg/L), P-Se from 53.6 to 913 µg/L (median 135 µg/L), H-Se from 0.4 to 3.8 µg/g (median 0.7 µg/g) and U-Se from 2.3 to 1375 µg/g cr. (median 33.6 µg/g cr.). Median B-Hg and B-Pb levels were 42.5 µg/L and 113 µg/L respectively. In multivariable analysis, Se biomarkers (log-transformed) were positively related to better performance on all motor tests, taking into account socio-demographic co-variables and B-Hg and B-Pb levels. P-Se consistently showed stronger associations to motor performance compared to the other Se biomarkers. Regression estimates for Se biomarkers were considerably stronger when controlling for B-Hg. When stratifying at the median for B-Hg concentrations, P-Se consistently presented associations with the outcomes only at high B-Hg concentrations. This is the first human study to report beneficial effects of high Se status on motor functions. For this population with elevated Hg exposure, high dietary Se intake may be critical for brain and muscle functions. However, these findings are not necessarily applicable to populations with lower Hg exposure and/or Se status, which is the case for people who do not rely heavily on fish consumption, be they in Brazil, the United States or elsewhere. The associations were mostly observed with P-Se, suggesting that P-Se or plasma selenoproteins may be good biomarkers for these outcomes.

Selenium and mercury in the Brazilian Amazon: opposing influences on age-related cataracts.

BACKGROUND: Age-related cataracts (ARCs) are an important cause of blindness in developing countries. Although antioxidants may be part of the body's defense to prevent ARC, environmental contaminants may contribute to cataractogenesis. In fish-eating populations of the lower Tapajós region, elevated exposure to mercury (Hg) has been reported, and blood levels of selenium (Se) range from normal to very high (> 1,000 microg/L). OBJECTIVES: We examined ARCs in relation to these elements among adults (> or = 40 years of age) from 12 riverside communities. METHODS: Participants (n = 211) provided blood samples and underwent an extensive ocular examination. Inductively coupled plasma mass spectrometry was used to assess Hg and Se in blood and plasma. RESULTS: One-third (n = 69; 32.7%) of the participants had ARC. Lower plasma Se (P-Se; < 25th percentile, 110 microg/L) and higher blood Hg (B-Hg; > or = 25th percentile, 25 microg/L) were associated with a higher prevalence odds ratio (POR) of ARC [adjusted POR (95% confidence interval), 2.69 (1.11-6.56) and 4.45 (1.43-13.83), respectively]. Among participants with high P-Se, we observed a positive but nonsignificant association with high B-Hg exposure, whereas among those with low B-Hg, we observed no association for P-Se. However, compared with the optimum situation (high P-Se, low B-Hg), the POR for those with low P-Se and high B-Hg was 16.4 (3.0-87.9). This finding suggests a synergistic effect. CONCLUSION: Our results suggest that persons in this population with elevated Hg, the cataractogenic effects of Hg may be offset by Se. Because of the relatively small sample size and possible confounding by other dietary nutrients, additional studies with sufficient power to assess multiple nutrient and toxic interactions are required to confirm these findings.